Professor of Physical Therapy with focus on human movement (Kinesiology and Pathokinesiology), Applied Measurement (Psychometric properties), and Applied Statistics for Rehabilitation research. Phone: 808-236-3574
Introduction: Medical diagnostic tests are evaluated based on measures of sensitivity (Sn), speci... more Introduction: Medical diagnostic tests are evaluated based on measures of sensitivity (Sn), specificity (Sp), and likelihood ratios (LR). These procedures are limited in the event of a biased gold standard or missing data. Interpretations of these measures are frequently inappropriate. Purpose: The Rasch measurement model (RMM) was examined as a method to provide evidence of diagnostic test utility in order to overcome the limitations of Sn, Sp, and LR. Methods: Patients suspected of a knee ligament tear (n = 825) were studied, by evaluating four diagnostic tests. The RMM probability estimates for each test were compared to estimates of Sn, Sp, and LR. Results: The RMM provided probability estimates for the diagnosis that were comparable to likelihood ratios. These probability estimates correlated with the estimates of Sn, Sp, and LR. The RMM estimates were not affected by missing data. Discussion: The RMM may provide an alternative means to study the utility of medical diagnostic tests to estimate the probability of disease presence/absence.
SUMMARY The professions of physical therapy and occupational therapy have legitimate roles in the... more SUMMARY The professions of physical therapy and occupational therapy have legitimate roles in the restoration of human movement in the rehabilitation process. This paper first presents a physical therapy perspective on changing trends in therapeutic exercise. Recent trends in physical therapy reflect a shift away from isolating patterns of movement and open kinetic chain exercises toward a new emphasis on functional patterns of movement and closed kinetic chain exercises. Rehabilitation of persons with hip fracture is used as an example of these shifting trends. Next, the paper presents an occupational therapy perspective. Occupational therapy's historical emphasis on the use of naturalistic occupations as the context for therapeutic exercise is described. Theoretical advantages of occupationally embedded movement are listed, and recent research in support of naturalistic occupations is summarized. Physical therapy and occupational therapy are distinct professions with autonomous outlooks and terminologies, but the responsibilities of physical therapists and occupational therapists potentially overlap in the restoration of movement. Suggestions are made for interdisciplinary teamwork whereby the holistically considered welfare of the patient is always the primary concern of all therapists.
IntroductionWalking while texting can create gait disturbances that may increase fall risk, espec... more IntroductionWalking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments.MethodsTwenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments.ResultsWhile there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008).DiscussionDual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.
This chapter focuses on resistance training and the physiologic effects on athletes and individua... more This chapter focuses on resistance training and the physiologic effects on athletes and individuals who have injuries or those who have permanent physical disabilities.https://digitalcommons.chapman.edu/pt_books/1001/thumbnail.jp
Medicine & Science in Sports & Exercise, 2020
Tandem gait has emerged as a dynamic and clinically viable test of dynamic motor control followin... more Tandem gait has emerged as a dynamic and clinically viable test of dynamic motor control following sport-related concussion (SRC). A myriad of tools are available to objectively assess gait kinematics. One piece of equipment, the Tekscan Strideway, uses individual load cells on a series of connected force platform tiles to quantify gait. No data exists that examines the performance of SRC using this device. PURPOSE: The purpose of this study was to evaluate the differences in center of pressure (CoP) performance during single-task (ST) and dual-task (DT) tandem gait within 24-48 hours postSRC. METHODS: 18 Division I [SRC (age: 19 ± 1.00 yr. Male=7, Female=11)] and 18 nearly matched controls [CON (age: 19.88 ± 1.05 yr. Male=7, Female=11)] completed the vestibular ocular motor screening test (VOMS) and 3 trials of ST and 1 trial of DT (serial 7s) using the Tekscan Strideway (30Hz, Boston, MA). The raw CoP trajectory for the best tandem gait trial of each condition (fastest overall) was exported and further analyzed using a custom MATLAB code. All turns during the tandem gait trials were removed and each straight path walking was composed together. The raw CoP data in the AP and ML directions were smoothed using empirical mode decomposition and then excursion and velocity data were calculated. T-tests compared the time to complete ST and DT while two multivariate ANOVAs compared CoP in the AP and ML directions. RESULTS: SRC took significantly longer to complete the ST trial (p=.006; SRC=14.2±4.4s, CON=10.8±2.1s) but not the DT trial (p=.279). The SRC group had a larger VOMS near-point convergence (NPC) (p=.007; SRC=9.5±5.5cm, CON=5.2±2.9cm) and a higher VOMS change score (p<.001; SRC=19.7±6.4, CON=0±0). A significant omnibus effect was noted in AP direction (p=.015) but not in the ML direction (p=.996) for the tandem gait CoP data. Follow-up comparisons noted that in the AP direction during ST, SRC had slower CoP excursion (p=.003; SRC=1.6±0.2cm, CON=1.9±0.4cm) and lower CoP velocity (p=.004; SRC=54.2±7.7cm/s, CON=66.1±14.2cm/s) but no differences during DT. CONCLUSIONS: These results suggest that during instrumented ST tandem gait, SRC have a more conservative and slower heel-to-toe stepping pattern.
Introduction: Medical diagnostic tests are evaluated based on measures of sensitivity (Sn), speci... more Introduction: Medical diagnostic tests are evaluated based on measures of sensitivity (Sn), specificity (Sp), and likelihood ratios (LR). These procedures are limited in the event of a biased gold standard or missing data. Interpretations of these measures are frequently inappropriate. Purpose: The Rasch measurement model (RMM) was examined as a method to provide evidence of diagnostic test utility in order to overcome the limitations of Sn, Sp, and LR. Methods: Patients suspected of a knee ligament tear (n = 825) were studied, by evaluating four diagnostic tests. The RMM probability estimates for each test were compared to estimates of Sn, Sp, and LR. Results: The RMM provided probability estimates for the diagnosis that were comparable to likelihood ratios. These probability estimates correlated with the estimates of Sn, Sp, and LR. The RMM estimates were not affected by missing data. Discussion: The RMM may provide an alternative means to study the utility of medical diagnostic tests to estimate the probability of disease presence/absence.
SUMMARY The professions of physical therapy and occupational therapy have legitimate roles in the... more SUMMARY The professions of physical therapy and occupational therapy have legitimate roles in the restoration of human movement in the rehabilitation process. This paper first presents a physical therapy perspective on changing trends in therapeutic exercise. Recent trends in physical therapy reflect a shift away from isolating patterns of movement and open kinetic chain exercises toward a new emphasis on functional patterns of movement and closed kinetic chain exercises. Rehabilitation of persons with hip fracture is used as an example of these shifting trends. Next, the paper presents an occupational therapy perspective. Occupational therapy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s historical emphasis on the use of naturalistic occupations as the context for therapeutic exercise is described. Theoretical advantages of occupationally embedded movement are listed, and recent research in support of naturalistic occupations is summarized. Physical therapy and occupational therapy are distinct professions with autonomous outlooks and terminologies, but the responsibilities of physical therapists and occupational therapists potentially overlap in the restoration of movement. Suggestions are made for interdisciplinary teamwork whereby the holistically considered welfare of the patient is always the primary concern of all therapists.
IntroductionWalking while texting can create gait disturbances that may increase fall risk, espec... more IntroductionWalking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments.MethodsTwenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments.ResultsWhile there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008).DiscussionDual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.
This chapter focuses on resistance training and the physiologic effects on athletes and individua... more This chapter focuses on resistance training and the physiologic effects on athletes and individuals who have injuries or those who have permanent physical disabilities.https://digitalcommons.chapman.edu/pt_books/1001/thumbnail.jp
Medicine & Science in Sports & Exercise, 2020
Tandem gait has emerged as a dynamic and clinically viable test of dynamic motor control followin... more Tandem gait has emerged as a dynamic and clinically viable test of dynamic motor control following sport-related concussion (SRC). A myriad of tools are available to objectively assess gait kinematics. One piece of equipment, the Tekscan Strideway, uses individual load cells on a series of connected force platform tiles to quantify gait. No data exists that examines the performance of SRC using this device. PURPOSE: The purpose of this study was to evaluate the differences in center of pressure (CoP) performance during single-task (ST) and dual-task (DT) tandem gait within 24-48 hours postSRC. METHODS: 18 Division I [SRC (age: 19 ± 1.00 yr. Male=7, Female=11)] and 18 nearly matched controls [CON (age: 19.88 ± 1.05 yr. Male=7, Female=11)] completed the vestibular ocular motor screening test (VOMS) and 3 trials of ST and 1 trial of DT (serial 7s) using the Tekscan Strideway (30Hz, Boston, MA). The raw CoP trajectory for the best tandem gait trial of each condition (fastest overall) was exported and further analyzed using a custom MATLAB code. All turns during the tandem gait trials were removed and each straight path walking was composed together. The raw CoP data in the AP and ML directions were smoothed using empirical mode decomposition and then excursion and velocity data were calculated. T-tests compared the time to complete ST and DT while two multivariate ANOVAs compared CoP in the AP and ML directions. RESULTS: SRC took significantly longer to complete the ST trial (p=.006; SRC=14.2±4.4s, CON=10.8±2.1s) but not the DT trial (p=.279). The SRC group had a larger VOMS near-point convergence (NPC) (p=.007; SRC=9.5±5.5cm, CON=5.2±2.9cm) and a higher VOMS change score (p<.001; SRC=19.7±6.4, CON=0±0). A significant omnibus effect was noted in AP direction (p=.015) but not in the ML direction (p=.996) for the tandem gait CoP data. Follow-up comparisons noted that in the AP direction during ST, SRC had slower CoP excursion (p=.003; SRC=1.6±0.2cm, CON=1.9±0.4cm) and lower CoP velocity (p=.004; SRC=54.2±7.7cm/s, CON=66.1±14.2cm/s) but no differences during DT. CONCLUSIONS: These results suggest that during instrumented ST tandem gait, SRC have a more conservative and slower heel-to-toe stepping pattern.
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Papers by Daniel Cipriani